Ali Merzah - Academia.edu (original) (raw)

Papers by Ali Merzah

Kliničeskaâ i èksperimentalʹnaâ hirurgiâ, 2020

Journal of Heart and Lung Transplantation, Apr 1, 2020

PURPOSE Despite maximal medican and surgical therapy, the outcomes of severe biventricular failur... more PURPOSE Despite maximal medican and surgical therapy, the outcomes of severe biventricular failure remain poor with mortality rates of up to 100%. The only definite therapy option for this disease is the total replacement of the heart - either by cardiac transplantation or by total artificial heart (TAH) implantation. Due to the lack of donor organs, mechanical assist devices are the most relevant option for these patients. The permanent availability of mechanical devices is especially attractive in emergency cases as well as in high-risk patients. The placement of two HeartMate 3 in the setting of a TAH is an alternative approach to pulsatile TAH implantation. We now present the worldwide first series of outcomes of this novel procedure. METHODS We performed a retrospective analysis of seven consecutive patients who underwent off-label HeartMate 3 TAH implantation after cardiectomy at two international medical institions. Data was acquired using the in-house clinical databases. Follow-up time was thirty days postoperatively. Among perioperative baseline characteristics, adverse events and survival data were collected and analyzed. The retrospective study was approved by the loca institutional ethics committee. RESULTS Out of 7 patients 4 were male (57%). Primary diagnosis was dilated cardiomyopathy in four cases (4/7, 57%) Other diagnoses were stone heart syndrome, restrictive cardiomyopathy and post-partum cardiomyopathy. All patients were previously supported by ECMO. 3 patients suffered from severe ventricular thrombosis. Intraoperative mortality was 0%. One patient was successfully transplanted after 71 days on device. One patient is still on-going on the device, currently discharged and waiting for heart transplantation (POD 259). Full mobility was achieved in both patients. In all cases postoperative hemodynamic stability was successfully achieved. No device related technical complications occured. Four patients died within thirty days of support (51%; POD 10-21). Causes of death were sepsis and multi-organ failure (3/4) and stroke (1/4). CONCLUSION It has been proven that the implantation of two HeartMate 3 VADs in the settings of a total artificial heart is a feasible concept with no technical adverse events in our patient population. In this high risk patient cohort, a reduction of 30-day-mortality from 100% to 57% was achieved.

The Thoracic and Cardiovascular Surgeon, 2020

Journal of Heart and Lung Transplantation, 2020

The Journal of Heart and Lung Transplantation, 2020

2760 patients (pts) who underwent continuous-flow (CF) long-term LVAD implantation. LVAD implanta... more 2760 patients (pts) who underwent continuous-flow (CF) long-term LVAD implantation. LVAD implantation was associated with a single CCP in 533 pts (19.3%). A propensity score (PS) matching (LVAD pts, n=481 vs. LVAD+CCP pts, n=481) analysis has been perfomed. Results: Intensive care unit (ICU) stay (20.9 vs. 25.5 days, p=0.019) and major bleeding requiring rethoracotomy (4.1% vs. 7.2%, p=0.027) resulted to be more frequent in LVAD+CPP cohort. Hospital mortality (17.4% vs. 22.2%, p=0.063) resulted to be comparable. Only coronary artery bypass grafting (p=0.041, OR 2.03, CI 1.03-4.02) did impact negatively. Extremes of body mass index (BMI), preoperative poor haemodynamics, dependance on inotropes infusion and extracorporeal life support (ECLS) resulted to be risk factors, after adjustment for baseline characteristics. During the mid-to long-term postoperative period, LVAD+CCP population showed higher incidence of bleeding (6.9% vs. 10.8%, p=0.031) and infectious adverse events (9.6% vs. 15.4%, p=0.022), respectively. Follow-up mortality (22.5% vs. 20.3%, p=0.432) resulted to be comparable. Valve surgery concomitant with LVAD implant seemed not to be associated with poor clinical outcomes (p=0.785). Mitral valve repair resulted to be protective in the long-term period (p=0.041), while tricuspid valve repair did not have any influence (p=0.108). No differences were observed by Kaplan-Meier survival analysis in the two cohorts (log-rank p=0.81, PS matched). Conclusion: In summary, performance of CCPs may not increase perioperative mortality and type of concomitant surgery addressed should be properly weighted. Mid-to long-term survival is not influenced by CCPs. This, however, remains a delicate population to be strictly monitored and homogeneously managed to preserve satisfactory outcomes.

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie

BACKGROUND Literature on the air travel activities of patients supported by permanent mechanical ... more BACKGROUND Literature on the air travel activities of patients supported by permanent mechanical assist devices is rare. To the best of our knowledge, no air travel-guidelines or fitness prerequisites exist on whether and when ventricular assist device (VAD) patients are allowed to travel by plane after device implantation. In this study, we evaluated the topic of air travel after VAD implantation. This working group aim to produce a report on air travel passengers supported by VADs, regarding their fitness to fly. METHODS Fifty LVAD patients were surveyed in a worldwide multi-center study. The single survey was performed with a multi-method design, including interviews conducted face-to-face, online and on phone. RESULTS Out of 50 patients, 97% described their traveling by aircraft as perfect and uneventful during the flight. 85% of the study participants consulted their medical practitioner before the flight. No patient reported the occurrence of a severe condition associated with...

Artificial organs, 2021

An intra-cavitary left ventricular (LV) thrombus is a relative contraindication to LV assist devi... more An intra-cavitary left ventricular (LV) thrombus is a relative contraindication to LV assist device (LVAD) implantation based on increased thromboembolic risks. Herein, we present our experience with LVAD patients with or without preoperative diagnosis of LV-thrombus. We retrospectively investigated 563 patients who received LVAD implantation between 2004 and 2018. Diagnosis of LV-thrombus was verified with computed tomography scan, magnetic resonance imaging, echocardiography or intraoperative LV inspection. The primary endpoint was 30-day survival free of stroke and pump thrombosis. Overall, 72 patients (12.8%) had a diagnosis of LV-thrombus. They were younger (51 years; IQR:41-59), affected by severely reduced ejection fraction (15%; IQR:10-20), more often presenting with dilated cardiomyopathy (61.8%) and INTERMACS profile 1 (33.3%). Preoperative atrial fibrillation was frequent in patients without LV-thrombus (38.9%). Conventional sternotomy was the preferred approach in LV-thr...

The Journal of cardiovascular surgery, 2021

BACKGROUND Device exchange to a newer generation left ventricular assist device (LVAD) offers the... more BACKGROUND Device exchange to a newer generation left ventricular assist device (LVAD) offers the opportunity to benefit from improved adverse events profiles. We present the three year results of a patient cohort undergoing VAD upgrades to a new generation device focusing on outcomes and adverse events. METHODS We present the first series of patients who underwent LVAD upgrade to HeartMate 3. All operations were performed less invasively. Follow-up time was three years after LVAD exchange. RESULTS Overall four HeartMate II and two HVAD patients underwent LVAD upgrade. In five cases severe infection of the VAD led to device exchange (83%, 5/6). Three year survival after LVAD exchange was 100% (6/6). In the follow-up examinations one patient showed a single syncope and several low flow alarms (1/6). The remaining five patients showed no technical malfunctions of the LVAD or hemodynamic adverse events (5/6). Four out of five patients whose devices had to be changed due to an infection...

Expert Review of Medical Devices